Diagnóstico tomográfico en pacientes con COVID-19, guía de observación y reporte

La expansión de la pandemia de COVID-19 incrementó el interés en la utilidad y pertinencia del diagnóstico por imágenes en el manejo de pacientes sospechosos o confirmados. El trabajo pretende comunicar elementos para facilitar la interpretación de la información ofrecida por la tomografía computarizada y brindar una guía básica, a partir de los hallazgos observados en 1622 pacientes, para el análisis de las imágenes tomográficas. Se realizó una revisión, análisis crítico y sistematización de la información encontrada a partir de una búsqueda en las bases de datos y motores Medline, Epistemonikos, LibreOffice Base, Microsoft Academic, ClinicalKey, Science Research y MedNar con el criterio: imagen en SARS-CoV-2 (COVID-19), en inglés y español. En COVID-19 no todo es opacidad en vidrio esmerilado. Si bien son las lesiones más observadas, se resalta, como característico, la distribución de las mismas predominantemente periféricas, multifocales, bilaterales, posteriores y con una tendencia a la asimetría; más tarde, en la evolución, seguiría el patrón en empedrado. Este y otros hallazgos menos frecuentes pueden ser encontrados en alguna fase del curso de la enfermedad. En el trabajo se propone una guía de observación para la correcta interpretación de la tomografía del paciente con COVID-19.

The spread of COVID-19 pandemics increased interest in the usefulness and pertinence of imaging diagnosis in the management of suspected or confirmed patients. This work aims to communicate elements to facilitate the interpretation of the information offered by computed tomography and provide a basic guide, based on the findings observed in 1622 patients, for the analysis of tomographic images. A review, critical analysis and systematization of the information―found from a search in Medline, Epistemonikos, LibreOffice Base, Microsoft Academic, ClinicalKey, Science Research y MedNar databases and engines―was carried out, with the criterion: image in SARS-CoV-2 (COVID-19), in English and Spanish. In COVID-19 not everything is opacity in ground glass. Although they are the most observed lesions, their distribution predominantly peripheral, multifocal, bilateral; posterior and with a tendency to asymmetry is highlighted as characteristic; later, in the evolution, they will follow the crazy paving pattern. This and other less frequent patterns may be found at some stage in the course of the disease. An observation guide for the correct interpretation of the tomographic imaging of patients with COVID-19 is proposed in the work.

Research progress of treatment options on spontaneous isolated superior mesenteric artery dissection based on computed tomography imaging classification / 中华消化外科杂志

Because of the low incidence rate, spontaneous isolated superior mesenteric artery dissection (SISMAD) is once considered as a rare disease. In recent years, with the widespread application of enhanced computed tomography (CT), reports of SISMAD have increased. At present, there is no consensus on the optimal treatment of SISMAD, and there are various imaging classifica-tions based on CT. However, clinical management strategy for SISMAD according to any imaging classification based on CT has not yet been acknowledged. Foreign scholars believe that conservative treatment can improve symptoms in most SISMAD patients, while Chinese scholars prefer endo-vascular intervention. The authors review the research progress of treatment options on SISMAD based on computed tomography imaging classification.

A comparative study of automatic delineation of organs at risk for prostate cancer based on deep learning and atlas library / 中华放射医学与防护杂志

Objective:To compare the effect of uPWS R15 software based on deep learning with MIM-Maestro 6.9 software based on atlas library to automatically delineate the organs at risk of prostate cancer in order to provide a reference for clinical application.Methods:The CT data of 90 prostate cancer patients admitted to the Department of Oncology Radiotherapy of the Affiliated Hospital of North Sichuan Medical College from 2018 to 2022 were retrospectively selected. Based on the uPWS R15 software developed by Shanghai United Imaging Medical Technology Company and the MIM-Maestro 6.9 software developed by Beijing Mingwei Vision Medical Software Company, the effects of uPWS and MIM software on automatic delineation of organs at risk were evaluated according to five parameters, including delineation time (T), Dice similarity coefficient (DSC), Jaccard similarity coefficient (JSC), Hausdorff distance (HD) and the mean distance to agreement (MDA).Results:The sketching time of uPWS software was less than that of MIM software. There were no significant differences in the sketching effect of femoral head and skin between the two software (all P>0.05). The delineation of right kidney ( tMDA=-3.43, zDSC=-4.03, zJSC=-4.16, P<0.05), left kidney ( tMDA=-3.87, zDSC=-4.18, zJSC=-4.41, P<0.05), small intestine ( tMDA=-8.57, zDSC=-9.99, tJSC=14.21, P<0.05) and rectum ( zMDA=-4.00, tDSC=-9.98, tJSC= 9.72, P< 0.05) except HD, was statistically different. The bladder ( z=-7.88, -9.00, -8.17, -8.74, P<0.05) and spinalcord ( z=-3.87, -4.43, 4.03, 3.05, P<0.05) were also delineated with significant differences. The DSC automatically delineated by uPWS software was >0.7, while the DSC automatically delineated by MIM software was >0.7 for all other organs at risk except small intestine and rectum. In addition, the HD, MDA and JSC values of the organs at risk (bilateral femoral head, bilateral kidneys, spinal cord, bladder, skin, rectum and small intestine) automatically delineated by uPWS software were generally better than those with MIM software. Conclusions:The uPWS software outlines better than the MIM software, but the MIM software can also be used clinically with modifications to the small bowel and rectum, saving a great deal of time in preparation for radiation therapy.

Rendimiento de escalas de trauma ISS, NISS y RTSen accidentes de tránsito para predecir mortalidad en un hospital de alta complejidad / Performance of ISS, NISS, and RTS trauma scales in traffic accidents to predict mortality in a high-complexity hospital

Introducción. La población mundial crece y con ello los accidentes de tránsito, incrementando la morbimortalidad. La combinación de factores clínicos y paraclínicos mediante las escalas de trauma impacta en los desenlaces al permitir tomar acciones oportunas. Métodos. Estudio de corte transversal en el que se incluyeron pacientes con lesiones por colisión en accidentes de tránsito, atendidos entre 2017 y 2018, en urgencias del Hospital Universitario San José de Popayán, Colombia, un hospital de alta complejidad. Se recolectaron variables sociodemográficas y biológicas y se aplicaron tres escalas de trauma, Revised Trauma Score, Injury SeverityScore y New Injury Severity Score. Posteriormente, se evaluó su rendimiento para predecir mortalidad. Resultados. Se atendieron en el servicio de urgencias 650 pacientes con lesiones en accidentes de tránsito y se presentaron 16 muertes. Al evaluar el rendimiento de las escalas de trauma se encontró que la sensibilidad para mortalidad varía entre el 75 % para Revised Trauma Score y el 93,8 % para Injury Severity Score y New Injury Severity Score, con una especificidad que varía entre 89,1 % y 96,8 %. Se identificó que la mejor razón de verosimilitud positiva fue para Revised Trauma Score, mientras que la mejor razón de verosimilitud negativa fue para Injury Severity Scorey New Injury Severity Score. Conclusiones. Los resultados evidencian un adecuado rendimiento de las escalas de trauma evaluadas para predecir mortalidad. La escala que presentó mejor rendimiento fue Injury Severity Score por su sensibilidad, especificidad y razón de verosimilitud positiva.

Background. The global population is on the rise and with such motor vehicle collisions, increasing the morbidity and mortality of individuals implicated in traffic accidents. The combination of clinical and paraclinical factors, as done by the different trauma scales, have an impact upon morbidity and mortality by allowing timely actions.Methods. Cross-sectional study that included patients with collision injuries in traffic accidents, treated at an emergency department from 2017 to 2018 at Hospital Universitario San José in Popayán, Colombia, a high-complexity hospital. The study defined the universe, collected sociodemographic and biological variables, and applied three trauma scales: Revised Trauma Score, Injury Severity Score, and New Injury Severity Score. Subsequently, its performance in predicting mortality was evaluated. Results. Six-hundred-fifty patients with collision injuries were treated in the emergency department with lesions due to collisions in traffic accidents; 16 deaths were reported. We found that the sensitivity varies between 75% for the Revised Trauma Score to 93.8% for the Injury Severity Score and the New Injury Severity Score. Likewise, an adequate specificity varying from 89,1% for the Injury Severity Score to 96,8% for the Revised Trauma Score. The best positive likelihood ratio was for the Revised Trauma Score. The negative likelihood ratios for the Injury Severity Score and the New Injury Severity Score were adequate.Conclusion. The results show an adequate performance of the trauma scales evaluated to predict mortality. The scale that presented the best performance was Injury Severity Score due to its sensitivity, specificity and positive likelihood ratio.

Predictive value of preoperative abdominal adipose tissue measurement for early recurrence after resection of hepatocellular carcinoma / 中华消化外科杂志

Objective:To investigate the predictive value of preoperative abdominal adipose tissue measurement for early recurrence after resection of hepatocellular carcinoma (HCC).Methods:The retrospective case-control study was conducted. The clinicopathological data of 238 patients with HCC who underwent surgical resection from January 2018 to January 2020 in 2 medical centers in China were collected, including 46 cases in the First Affiliated Hospital of Chongqing Medical University and 192 cases in the First Affiliated Hospital of Army Medical University. There were 207 males and 31 females, aged 51(48,65)years. All patients underwent abdominal computed tomography (CT) and/or magnetic resonance imaging (MRI) before surgery. Observation indicators: (1) measure-ment of abdominal adipose tissue; (2) follow-up; (3) analysis of influencing factors for early recurrence after resection of HCC; (4) prediction of early recurrence after resection of HCC. Follow-up was conducted by outpatient examinations and telephone interview to detect the postoperative survival of patients up to February 2022. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was performed by the t test. Measurement data with skewed distribution was represented by M(range) or M( Q1, Q3), and comparison between groups was performed by the Mann-Whitney U test. Count data were expressed as absolute numbers or percen-tages, and the chi-square test was used for comparison between groups. Univariate analysis was conducted using the corresponding statistical methods based on data type. Multivariate analysis was performed using the Logistic regression model advance method. The receiver operating characteristic curve was drawn, and the area under curve was used to evaluate the efficacy. Results:(1) Measure-ment of abdominal adipose tissue. Of the 238 patients, the total abdominal adipose tissue, visceral adipose tissue, subcutaneous adipose tissue, total adipose tissue index, visceral adipose tissue index, subcutaneous adipose tissue index were 292(198,355)cm 2, 153(99,194)cm 2, 128(95,154)cm 2, 106(76,130)cm 2/m 2, (57±27)cm 2/m 2, 46(34,58)cm 2/m 2 for 139 patients with early postoperative recur-rence, versus 174(114,251)cm 2, 78(50,110)cm 2, 88(55,127)cm 2, 64(42,91)cm 2/m 2, (30±16)cm 2/m 2, 31(19,46) cm 2/m 2 for 99 patients without early recurrence, respectively, showing significant diffe-rences between them ( Z=?7.39, ?7.87, ?5.03, ?7.25, t=?9.46, Z=?5.00, P<0.05). (2) Follow-up. All the 238 patients were followed up according to the plan. The survival time of 238 patients was 26(8,44)months. The survival time was 11(5,18)months for patients with postoperative early recur-rence, versus 36(32,43)months for patients without early recurrence, respectively. (3) Analysis of influencing factors for early recurrence after resection of HCC. Results of univariate analysis showed that body mass index, total adipose tissue, visceral adipose tissue, subcutaneous adipose tissue, total adipose tissue index, visceral adipose tissue index and subcutaneous adipose tissue index were related factors for early recurrence after resection of HCC ( t=?5.88, Z=?7.39, ?7.87, ?5.03, ?7.25, t=?9.46, Z=?5.00, P<0.05). Results of multivariate analysis showed that visceral adipose tissue index was an independent influencing factor for early recurrence after resection of HCC ( odds ratio=1.06, 95% confidence interval as 1.04?1.08, P<0.05). (4) Prediction of early recurrence after resection of HCC. According to the results of multivariate analysis, the receiver operating characteris-tic curve showed that the area under curve of visceral adipose tissue index was 0.80 (95% confidence interval as 0.75?0.86, P<0.05), with the sensitivity and specificity as 75.5% and 71.7%. Conclusions:Visceral adipose tissue index is an independent influencing factor for early recurrence after resection of HCC. The risk of early recurrence increases with the increase of visceral adipose tissue index.

External root resorption evaluated by CBCT 3D models superimposition

ABSTRACT Introduction: The literature reports the association of external root resorption (ERR) with orthodontic movement. In cases of premolars extractions, orthodontic movement of anterior teeth is usually quite expressive, which are precisely the most susceptible teeth to suffer from ERR. Objective: The aim of this study was to assess the root morphology of maxillary canines and incisors in patients submitted to four premolar extraction and orthodontic retraction of the anterior teeth, by means of 3D surface models superimposition and mapping. Methods: The sample consisted of six adult patients, five female and one male, with a mean age of 23.5 ± 6.5 years, who underwent orthodontic treatment. All patients presented bimaxillary dental protrusion, with indication of maxillary and mandibular first premolar extractions, followed by the retraction of anterior teeth and space closure. Cone beam CT scans were performed before the beginning of the treatment (T0) and right after space closure (T1). 3D models were built at both times and superimposed to identify the root changes for the given period. Results: All average differences were close to zero and, even when evaluating the extreme values, the observed changes were always smaller than the accuracy of the CBCT. Conclusion: A mild resorption trend was observed, although it was not clinically significant, with values lower than the tomography accuracy.

RESUMO Introdução: A literatura relata a associação de reabsorção radicular externa (RRE) com a movimentação ortodôntica. Nos casos de extrações de pré-molares, a movimentação ortodôntica costuma ser bastante expressiva nos dentes anteriores, que são justamente os dentes mais suscetíveis à RRE. Objetivo: O objetivo do presente estudo foi avaliar a morfologia radicular de caninos e incisivos superiores em pacientes submetidos à extração de quatro pré-molares e retração ortodôntica dos dentes anteriores, por meio da sobreposição e mapeamento de modelos 3D. Métodos: A amostra foi composta por seis pacientes adultos, cinco do sexo feminino e um do masculino, com média de idade de 23,5 ± 6,5 anos, submetidos a tratamento ortodôntico. Todos os pacientes apresentavam biprotrusão dentária, com indicação de extração dos primeiros pré-molares superior e inferior, seguida de retração dos dentes anteriores e fechamento do espaço. A tomografia computadorizada de feixe cônico (TCFC) foi realizada antes do início do tratamento (T0) e logo após o fechamento de espaços (T1). Modelos 3D foram construídos em ambos os momentos e sobrepostos para identificar as mudanças nas raízes dentárias no período determinado. Resultados: Todas as médias das diferenças foram próximas de zero e, mesmo avaliando os valores extremos, as mudanças observadas foram sempre menores que a sensibilidade da TCFC. Conclusão: Observou-se tendência de leve reabsorção, embora não clinicamente significativa, com valores inferiores à sensibilidade tomográfica.

Interpretation of Update: Standardized CT/HRCT Classification of Occupational and Environmental Thoracic Diseases in Germany published in 2014 / 中国职业医学

@#Imaging diagnosis is one of the main bases for the diagnosis of occupational pneumoconiosis. At present the - diagnosis of occupational pneumoconiosis is mainly based on high kV X ray chest radiography or chest digital radiography. With （ ） ， （ ） the wide application of computed tomography CT in occupational lung diseases high resolution CT HRCT is increasingly Update： Standardized CT/HRCT Classification of Occupational valuable in the diagnosis of occupational pneumoconiosis. The and Environmental Thoracic Diseases in Germany， ， published in 2014 is the latest and highly reliable standard. The standard - - - recommends the use of low dose HRCT scanning regimens and whole lung thin layer volumetric scanning with a thickness of - ， ， 1.0 mm and high resolution reconstruction which classify CT image quality into four levels and describes methods for （ ， classification and quantitative recording of CT manifestations of lung lesions including round opacities irregular and/or linear ， ， ， ， ） opacities ground glass opacity honeycombing emphysema and large opacities and pleural lesions. It is beneficial for ， ， ， epidemiological research early screening diagnosis and differential diagnosis treatment and prognosis of occupational ， pneumoconiosis as well as the comparison of international data related to occupational pneumoconiosis.

Interpretation of Update: Standardized CT/HRCT Classification of Occupational and Environmental Thoracic Diseases in Germany published in 2014 / 中国职业医学

@#Imaging diagnosis is one of the main bases for the diagnosis of occupational pneumoconiosis. At present the - diagnosis of occupational pneumoconiosis is mainly based on high kV X ray chest radiography or chest digital radiography. With （ ） ， （ ） the wide application of computed tomography CT in occupational lung diseases high resolution CT HRCT is increasingly Update： Standardized CT/HRCT Classification of Occupational valuable in the diagnosis of occupational pneumoconiosis. The and Environmental Thoracic Diseases in Germany， ， published in 2014 is the latest and highly reliable standard. The standard - - - recommends the use of low dose HRCT scanning regimens and whole lung thin layer volumetric scanning with a thickness of - ， ， 1.0 mm and high resolution reconstruction which classify CT image quality into four levels and describes methods for （ ， classification and quantitative recording of CT manifestations of lung lesions including round opacities irregular and/or linear ， ， ， ， ） opacities ground glass opacity honeycombing emphysema and large opacities and pleural lesions. It is beneficial for ， ， ， epidemiological research early screening diagnosis and differential diagnosis treatment and prognosis of occupational ， pneumoconiosis as well as the comparison of international data related to occupational pneumoconiosis.

Imaging features of 10 patients with toxic encephalopathy caused by diquat / 中华劳动卫生职业病杂志

Objective: To explore the CT and MRI imaging findings of diquat toxic encephalopathy. Methods: CT and MRI imaging features of 10 patients with diquat poisoning encephalopathy who had been clinically diagnosed were retrospectively reviewed. Results: CT was performed in all 10 patients, and MRI was performed in 8 patients. In 10 patients, 7 had positive signs on CT, and 8 patients with MRI examination had abnormal changes in the images. The main CT findings were symmetrical hypodensity in bilateral cerebellar hemisphere, brainstem, thalamus and basal ganglia, and swelling of brain tissue. The main MRI findings were symmetrical lesions and brain edema in the deep nuclei of cerebellar hemisphere, brainstem, thalamus and basal ganglia, low signal on T1WI, high signal on T2WI and T2-FLAIR, and cytotoxic edema on diffusion weighted imaging (DWI) . On review after treatment, both CT and MRI showed resorption of the lesion, which narrowed in size. Conclusion: The imaging findings of diquat poisoning encephalopathy are characteristic and the location of the lesion is characteristic, and CT and MRI have a certain diagnostic value in diquat poisoning encephalopathy, which is important for clinical treatment.

Clinical analysis of 30 cases of basal ganglia germinoma in children / 北京大学学报(医学版)

OBJECTIVE@#To summarize and analyze the clinical characteristics of children with basal ganglia germinoma and to improve the level of early clinical diagnosis.@*METHODS@#The clinical data of children diagnosed with basal ganglia germinoma admitted to the Pediatric Surgery Ward of Peking University First Hospital from January 2013 to December 2020 were retrospectively analyzed, and descriptive statistics were used to analyze the clinical characteristics of children with basal ganglia germinoma.@*RESULTS@#A total of 30 patients were included in the study, 28 were male, 2 were female, the mean age at onset was (9.7±2.2) years, the median disease duration was 7 months, 27 had unilateral disease, and 3 had bilateral disease. The clinical manifestations were decreased limb muscle strength, cognitive function disorders, polydipsia, precocious puberty, intracranial hypertension, dysphonia and swallowing dysfunction. The serum and cerebrospinal fluid tumor marker alpha-fetoprotein (AFP) were normal in the 30 patients, and the serum and cerebrospinal fluid tumor marker β-human chorionic gonadotropin (β-HCG) were normal in 8 patients.The serum β-HCG was normal in 11 patients but the cerebrospinal fluid β-HCG was slightly elevated, and the serum and cerebrospinal fluid β-HCG were slightly elevated in 11 patients. A total of 33 lesions with irregular shapes were found by imaging examination, including 15 (45.5%) patchy lesions, 10 (30.3%) patchy lesions, and 8 (24.2%) round-like high-density lesions. Tumors showed obvious high-density shadows on computed tomography (CT) scan. Magnetic resonance imaging (MRI) scan of the tumors showed low or isointensity on T1WI and isointensity on T2WI, accompanied by mild peritumoral edema, hemispheric atrophy, cerebral peduncle atrophy, calcification, cystic degeneration, ventricular dilatation and wallerian degeneration. On contrast-enhanced scans, the tumor showed no enhancement or heterogeneous enhancement.@*CONCLUSION@#The main age of onset of germ cell tumors in the basal ganglia in children is about 10 years old, and males are absolutely dominant. The clinical features and imaging manifestations have certain characteristics. With both combined, the early diagnosis of germ cell tumors in the basal ganglia can be improved.

Chest computed tomography findings of 1271 patients with COVID-19 pneumonia and classifications with different age groups: a descriptive study from Istanbul, Turkey

SUMMARY OBJECTIVE: The objectives of this study were to describe lung computed tomography findings of patients with COVID-19 diagnosed by real-time reverse transcription polymerase chain reaction test, investigate whether the findings differ regarding age and gender, and evaluate the diagnostic performance of chest computed tomography based on the duration of symptoms at the time of presentation to the hospital. METHODS: From March 11 to May 11, 2020, 1271 consecutive patients (733 males and 538 females) were included in this retrospective, cross-sectional study. Based on age, patients were divided into five separate subgroups. Then based on the duration of symptoms, patients were divided into five separate phases. The presence of lung lesion(s) and their characteristics, distribution patterns, and the presence of concomitant pleural thickening/effusion and other findings (malignancy, metastasis, chronic obstructive pulmonary disease, interstitial lung disease, bronchiectasis, bronchiectasis, cardiomegaly, pericardial effusion) were evaluated by five radiologists independently. RESULTS: The "normal lung computed tomography finding" was the most common chest CT finding (37%), followed by ground-glass opacity (31%). Regardless of the shape of the lesion, the distribution features were significant (peripheral, subpleural, and lower lobe distribution) (p<0.05). The presence of pleural thickening posteriorly and adjacent to the lesion was statistically different in groups 1-3 (p<0.05). Other concomitant pathologies, except pulmonary congestion, did not suppress the typical findings of COVID-19. CONCLUSION: Chest computed tomography findings were mostly normal in the early phase (P1). Therefore, it may be appropriate to perform the first computed tomography screening of COVID-19 after 6 days to decrease the radiation exposure.

Value of magnetic resonance combined with dual-source spectral computed tomography in improving the clinical diagnosis and treatment efficiency of lumbar disk herniation

SUMMARY OBJECTIVE: This study aims to investigate the value of magnetic resonance combined with dual-source spectral computed tomography in improving the clinical diagnosis and treatment efficiency of lumbar disk herniation. METHODS: Two hundred patients with lumbar disk herniation were enrolled. Magnetic resonance and dual-source spectral computed tomography were used to perform the diagnosis. The treatment efficiency and effectiveness of different diagnostic methods were determined. Results: Eighty cases of lumbar disk herniation, 40 cases of prolapse, 33 cases of bulge, 27 cases of sequestration, and 20 cases of nodules were diagnosed based on pathologic evaluation. magnetic resonance detected lumbar disk herniation in 172 cases, with a detection rate of 86.00%. Dual-source spectral computed tomography detected 171 cases, with a detection rate of 85.50%. Magnetic resonance combined with dual-source spectral computed tomography detected 195 cases, with a detection rate of 97.50%. There was no significant difference between magnetic resonance and dual-source spectral computed tomography (p>0.05), but compared with the combined detection, there was a significant difference (p<0.05). One hundred and two cases of calcification, 83 cases of spinal cord deformity, 70 cases of intervertebral disk degeneration, 121 cases of intervertebral disk gas, 85 cases of dural sac compression, and 78 cases of nerve root compression were surgically demonstrated. The detection rate of diagnostic signs based on imaging by magnetic resonance or dual-source spectral computed tomography alone was lower than that of combined detection (p<0.05). Conclusion: Magnetic resonance combined with dual-source spectral computed tomography can improve the diagnosis and treatment efficiency and effectiveness of lumbar disk herniation.

Some inflammatory markers and chest computerized tomography in patients with severe acute respiratory syndrome coronavirus infection

SUMMARY OBJECTIVE: We retrospectively assessed whether there was a relationship between lung complications and some easily accessible markers to predict the presence of pulmonary consolidation in patients with coronavirus disease 2019 (COVID-19). METHODS: According to the polymerase chain reaction and chest computerized tomography results, the study was categorized into three groups. Group 1 (n=87) included the patients with polymerase chain reaction (+), group 2 (n=55) included the patients with polymerase chain reaction (-) and chest computerized tomography (+), and group 3 (n=77) included the patients with polymerase chain reaction (-) and chest computerized tomography (-), respectively. RESULTS: High-sensitivity C-reactive protein and increased age were associated with higher computerized tomography (CT) scores. CONCLUSION: Increased age and C-reactive protein (CRP) may suggest pulmonary infiltration on chest CT in patients with COVID-19.

Comparison of Clinical Examination and Various Imaging Modalities in the Diagnosis of Head and Neck Cancer

Abstract Introduction Squamous cell Carcinoma of the Head and Neck (HNSCC) is the most common tumor entity of malignant processes in the head and neck area. Due to the metastasizing behavior of these tumors, the staging is indispensable for the treatment planning and requires imaging techniques, which are sensitive, specific, and as far as possible cost-effective, to benefit ultimately the patient and to ensure optimal care. Objectives The aim of the present study is to compare the clinical examination including palpation, ultrasound and computed tomography (CT)/magnetic resonance imaging (MRI) for the diagnosis of neck metastases to make the correct indication for a neck dissection. Methods Data from 286 patients with HNSCC were analyzed for neck metastases to determine which diagnostic tool is the best to answer the question if a neck dissection is necessary or not. Each study method was examined retrospectively by comparing sensitivity, specificity, the positive/negative predictive value, the positive likelihood ratio and the diagnostic accuracy. Results The ultrasound showed a sensitivity of 91.52%, a specificity of 61.67%, a positive/negative predictive value of 76.65%/84.09%, a positive likelihood ratio of 2.39 and a diagnostic accuracy of 78.95%. The clinical examination showed a sensitivity of 75.76%, a specificity of 66.12%, a positive/negative predictive value of 75.30%/66.67%, a positive likelihood ratio of 2.24 and a diagnostic accuracy of 71.68%. The CT/MRI showed a sensitivity of 78.66%, a specificity of 62.50%, a positive/negative predictive value of 74.14%/68.18%, a positive likelihood ratio of 2.10 and a diagnostic accuracy of 71.83%. Radiographically, ultrasound, as well as the clinical examination, could be judged to be free from radiation load and side effects from the contrast medium. The high dependence on the investigator when using ultrasound made reproducibility of the results difficult. Conclusions It could be shown that ultrasound was the diagnostic tool with the highest sensitivity, positive/negative predictive value, positive likelihood ratio and diagnostic accuracy by detecting and interpreting metastases in the head and neck region correctly. Whether a neck dissection should be performed depends to a large extent on the ultrasound findings.

Quantitative evaluation of computed tomography findings in patients with pulmonary embolism: the link between D-Dimer level and thrombus volume

SUMMARY OBJECTIVE: To investigate the correlation of D-dimer levels and computed tomography properties of pulmonary embolism. METHODS: A total of 58 treated patients with diagnosis of properties of pulmonary embolism were retrospectively studied. All patients underwent a D-dimer blood test. In computed tomography images, septal angle, interventricular septal thickness, and the diameters of all cardiac chambers and pulmonary arteries were measured. The thrombus volume (load) and density at all pulmonary arteries (main, right, left pulmonary arteries, and segmental arteries) were calculated. RESULTS: A significant correlation was found between D-dimer and total thrombus volume (p=0.009, r=0.342). Total thrombus volume and total thrombus density were calculated with mean value of 23.40±60.63 ml and 66.16±38.48 hounsfield unit (HU), respectively. Right ventricle/left ventricle ratio showed positive correlation with the D-dimer level (p=0.02). CONCLUSION: Increased D-dimer levels with RV/LV ratio and their correlation with total thrombus volume suggest that it may be a prognostic factor.

CT Characteristics of Consolidation Type of Pulmonary Cryptococcosis in Immunocompetent Patients / 中国医学科学院学报

Objective To analyze the CT characteristics of consolidation type of pulmonary cryptococcosis in immunocompetent patients,and thus improve the diagnosis of this disease. Methods A total of 20 cases with consolidation-type pulmonary cryptococcosis confirmed by pathological examinations were studied.Each patient underwent breath-hold multislice spiral CT,and 10 patients underwent contrast enhanced CT.The data including lesion number,lesion distribution,lesion density,performance of enhanced CT scan,accompanying signs,and prognosis were analyzed. Results The occurrence rates of single and multiple lesions were 80.0%(n=16)and 20.0%(n=4),respectively.In all the 16 multiple-lesion patients,the occurrence rate of unilateral lobar distribution was 56.0%(n=9).The 76 measurable lesions mainly presented subpleural distribution(71.1%,n=54)and lower pulmonary distribution(75.0%,n=57).A total of 39 lesions were detected in the 10 patients received contrast enhanced CT,in which 31 lesions(79.5%)showed homogeneous enhancement,34 lesions(87.2%)showed moderate enhancement,and all the lesions manifested angiogram sign.Consolidation lesions were accompanied by many CT signs,of which air bronchogram sign had the occurrence rate of 63.2%(n=48),including types Ⅲ(n =37)and Ⅳ(n=11).Other signs included halo signs(43/76,56.6%),vacuoles or cavities(9/76,11.8%),pleural thickening(14/20,70.0%),and pleural effusion(2/20,10.0%).After treatment,the lesions of 7 patients were basically absorbed and eventually existed in the form of fibrosis. Conclusions The lesions in the immunocompetent patients with consolidation type of pulmonary cryptococcosis usually occur in the lower lobe and close to the pleura,mainly presenting unilateral distribution.The CT angiogram signs,proximal air bronchogram signs,and halo signs are the main features of this disease,which contribute to the diagnosis.

Pedicle Screws and Facet Violation - The importance of the Angle between the Facet and the Screw / Parafusos pediculares e violação facetária - A importância do ângulo entre a faceta e o parafuso

Abstract Objective To verify whether, regardless of the screw placement technique, there is a safe distance or angle in relation to the facets that can prevent violation of the facet joint when the screws are placed. Methods Retrospective, single, comparative, non-randomized center. We evaluated by axial computed tomography: the angle of the screw/rod in relation to the midline, the angle of the center of the facets in relation to the midline, the distance between the head of the screw/rod to the midline, and the distance from the center of the facets to the midline; the violation of the facet joint will be evaluated in a gradation of 0 to 2. Also will be measured the difference between the angle os the facets and the angle of the screws (Δ Angle) and, the difference between the facet distance and the screw distance (Δ Distance). Results A total of 212 patients and 397 facets were analyzed (196 on the left and 201 on the right). Of these, 303 were not violated (grade 0), corresponding to 76,32%, and 94 suffered some type of violation (grade 1 and 2), corresponding to 23,68%. The mean of Δ angle was 9.87° +/− 4.66° (grade 0), and of 3.77° +/− 4.93° in facets (grade 1 and 2) (p< 0.001), and the Δ mean distance in cases in which there was no violation was 0.94 arbitrary units (a.u.) +/− 0.39 a.u., while the Δ distance in G1 and G2 cases was 0.56 a.u. +/− 0.25 a.u. (p< 0.001). Conclusion The measurements of angle and distance between facet and screw can help in the placement of screws. These parameters can be used as safety measures with the most frequent use of surgical navigation techniques.

Resumo Objetivo Verificar se, independente da técnica de colocação do parafuso, há uma distância ou angulação segura em relação as facetas para que os parafusos sejam colocados de modo a evitar a violação da articulação facetária. Métodos Estudo retrospectivo, comparativo, não randomizado, em centro único. Foram avaliados em tomografia computadorizada axial: o ângulo do parafuso/barra em relação a linha média, o ângulo do centro das facetas em relação a linha média, a distância entre a cabeça do parafuso/barra até a linha média, e a distância do centro das facetas até a linha média; a violação da articulação facetária será avaliada em uma gradação de 0 a 2. Serão também calculados a diferença entre o ângulo do parafuso e ângulo da faceta (Δ Ångulo) e também a diferença entre a distância da faceta e a distância do parafuso (Δ Distância). Resultados Um total de 212 pacientes e 397 facetas foram analisados (196 do lado esquerdo e 201 do lado direito). Destes, 303 foram não violados (grau 0), correspondendo a 76,32%, e 94 sofreram algum tipo de violação (grau 1 e 2), correspondendo a 23,68%. A média do Δ ângulo foi de 9,87° +/− 4,66° (grau 0) e de 3,77° +/− 4,93° em facetas (grau 1 e 2) (p< 0.001), e o Δ distância médio nos casos em que não houve violação foi de 0,94 unidades aleatórias (u.a.) +/− 0,39 u.a., enquanto o Δ distância de casos G1 e G2 foi de 0,56 u.a. +/− 0,25 u.a. (p< 0.001). Conclusão As medidas de ângulo e distância entre faceta e parafuso, podem auxiliar na colocação de parafusos. Esses parâmetros podem ser utilizados como medidas de segurança com o uso mais frequentes das técnicas de navegação cirúrgica.

Application of the transosseous approach for computed tomography-guided radioactive 125-iodine seed implantation for the treatment of thoracic and abdominal lymph node metastases

Aim: This study aimed to investigate the technical procedure, safety, and clinical value of the transosseous approach for computed tomography (CT)-guided radioactive 125-iodine (125I) seed implantation for the treatment of thoracic and abdominal lymph node metastases. Subjects and Methods: This was a retrospective study that Nine lymph node metastases in nine patients were treated in our hospital between January 2010 and August 2018. Under CT guidance, at least one puncture path was made through the transosseous approach. The seeds were planted according to the TPS. CT/MRI scans were performed every 2 months after the treatment to evaluate local therapeutic efficacy according to the Response Evaluation Criteria in Solid Tumors. Results: The transosseous approach was successfully established in all patients. The median follow-up time was 11 months (6–36 months). At 2, 4, 6, 8, 10 and 12 months after operation, the objective effective rate and clinical benefit rate were 66.67%, 77.78%, 77.78%, 71.43%, 66.67% and 50.00%; and 88.89%, 88.89%, 88.89%, 71.43%, 66.67% and 50.00%, respectively. The survival rate of the patients at 6, 12, 18, 24, 30 and 36 months after operation was 53.00%, 26.00%, 26.00%, 13.00%, 13.00% and 13.00%, respectively. Conclusions: The transosseous approach for CT-guided radioactive 125I seed implantation was safe, effective, and minimally invasive for the treatment of thoracic and abdominal lymph node metastases

Radiography study on osteotome sinus floor elevation with placed implant simultaneously with no graft augmentation / 北京大学学报(医学版)

OBJECTIVE@#To investigate the change of endo-sinus bone height and bone volume in osteotome sinus floor elevation (OSFE) without bone graft but placing implants simultaneously by using cone beam computed tomography (CBCT) and three dimensional analysis, and to find the impacting factors on endo-sinus bone augmentation.@*METHODS@#OSFE was performed in 38 edentulous patients with missing teeth at posterior maxillary region, and 44 implants were placed and referred for OSFE using no graft materials. CBCT was performed pre-surgery and 9－68 months post-surgery when the patients encountered another implant surgery. The gained bone height at mesial, distal, buccal and palatal sites around the implant in sinus were measured, volumetric measurements of the endo-sinus gained bone volume (ESGBV) in the elevated region were calculated by Mimics software. Univariate analysis and multiple linear regression were performed to investigate the impacting factors on the gained bone height and ESGBV. Marginal bone loss was recorded according to the periapical radiography after implant restoration.@*RESULTS@#The mean residual bone height (RBH) pre-surgery was (3.41±1.23) mm, the mean protruded length (PL) into sinus of implant post-surgery was (3.41±1.28) mm, the mean endo-sinus gained bone height was (2.44±1.23) mm at distal sites, (2.88±1.20) mm at mesial sites, (2.83±1.22) mm at buccal sites and (2.96±1.16) mm at palatal sites, the mean endo-sinus gained bone height at distal sites was significantly lower than the other three sites (P < 0.05). The average endo-sinus gained bone height was (2.78±1.13) mm. The mean ESGBV was (122.15± 73.27) mm3. Univariate analysis showed the more RBH, the less bone height gained in sinus, which existed at buccal, lingual, mesial and distal sites (P < 0.001), and the more RBH, the smaller ESGBV gained (P=0.012). The ESGBV was significantly higher in the subjects whose bone generation period was more than 24 months than those whose bone generation period less than 24 months (P=0.034). The more PL, the more bone height and ESGBV gained (P=0.008). Multivariate analysis showed after adjusting factors of gender, age, smoking, width of sinus floor, thickness of sinus membrane pre-surgery, diameter and length of the implant, PL and bone generation period was positively correlated with mean endo-sinus gained bone height and ESGBV, while RBH negatively correlated with mean endo-sinus gained bone height. During the follow-up, the mean marginal bone loss was 0 (0－1.41) mm and all the implants loaded successfully.@*CONCLUSION@#OSFE without bone graft but with placed implant simultaneously can increase endo-sinus gained bone height and ESGBV. RBH, PL and bone generation period are the significant factors impacting endo-sinus bone augmentation.

Evaluation of the frequency of neuroimaging findings in congenital infection by Zika virus and differences between computed tomography and magnetic resonance imaging in the detection of alterations

Abstract INTRODUCTION: Congenital infection by the Zika virus (ZIKV) is responsible for severe abnormalities in the development of the central nervous system. The aim of this study was to evaluate and compare the ability of computed tomography (CT) and magnetic resonance (MR) to detect patterns of involvement of the central nervous system in congenital ZIKV syndrome. METHODS: We retrospectively analyzed CT and MR images from 34 patients with congenital ZIKV syndrome and evaluated the differences between the two methods in detecting alterations. RESULTS: The predominant radiographic finding was a simplified gyral pattern, present in 97% of cases. The second most common finding was the presence of calcifications (94.1%), followed by ventriculomegaly (85.3%), dysgenesis of the corpus callosum (85.3%), craniofacial disproportion and redundant scalp (79.4%), complete opercular opening (79.4%), occipital prominence (44.1%), cerebellar hypoplasia (14.7%), and pontine hypoplasia (11.8%). The gyral pattern was extensively simplified in most cases, and calcifications were located predominantly at the cortical-subcortical junction. CT was able to better identify calcifications (94.1% × 88.2%), while MRI presented better spatial resolution for the characterization of gyral pattern (97% × 94.1%) and corpus callosum dysgenesis (85.3% × 79.4%). CONCLUSIONS: Although congenital ZIKV syndrome does not present pathognomonic neuroimaging findings, some aspects, such as calcifications at the cortical-subcortical junction, especially when associated with compatible clinical and laboratory findings, are suggestive of intrauterine ZIKV infection.